Deck 14: Antipsychotic Drugs

Question 1

When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for EPSEs, particularly:

A) akathisia.
B) mydriasis.
C) hypotension.
D) constipation.

Answer 1

akathisia.

Question 2

After an unsuccessful trial with fluphenazine (Prolixin), a patient's medication was changed to trifluoperazine (Stelazine). Three months later the patient is still hallucinating and delusional. What is the most likely explanation for the persistent symptoms?

A) Trifluoperazine (Stelazine) is a low-potency antipsychotic, and the patient might need higher doses.
B) The patient has not taken trifluoperazine (Stelazine) long enough to decrease symptoms significantly.
C) Delusions and hallucinations are negative symptoms of schizophrenia that do not respond to traditional antipsychotic medications.
D) Both fluphenazine (Prolixin) and trifluoperazine (Stelazine) are traditional antipsychotics, and the patient does not respond well to this class of drug.

Answer 2

Both fluphenazine (Prolixin) and trifluoperazine (Stelazine) are traditional antipsychotics, and the patient does not respond well to this class of drug.

Question 3

A patient receiving a traditional high-potency antipsychotic medication should be closely monitored for:

A) adrenergic effects.
B) extrapyramidal side effects.
C) anticholinergic side effects.
D) changes in pain perception.

Answer 3

extrapyramidal side effects.

Question 4

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, concerns for safety and physiologic stability require that the patient be carefully monitored for:

A) tardive dyskinesia.
B) gastrointestinal hyperactivity.
C) drug-induced parkinsonian movements.
D) orthostatic hypotension and cardiac arrhythmias.

Question 5

The patient receiving antipsychotic medication who should be most carefully monitored for development of neuroleptic malignant syndrome is the individual who:

A) has a history of hypothermia.
B) has an elevated serum prolactin level.
C) is beginning treatment with a high-potency drug.
D) has taken antipsychotics for more than 6 months.

Question 6

Thioridazine (Mellaril) is prescribed for a 72-year-old patient with a psychiatric disorder. It is most critical for the nurse to obtain information about preexisting:

A) cataracts.
B) heart disease.
C) diabetes mellitus.
D) chronic bronchitis.

Question 7

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic. What is the nurse's best first action?

A) Take the patient's vital signs.
B) Position the patient in the semi-Fowler's position.
C) Begin oxygen by nasal cannula at 2 L/min.
D) Place the patient on one-to-one supervision.

Question 8

A patient has taken a traditional antipsychotic medication for several years. The nurse observes involuntary tongue movements and lip smacking. The nurse should:

A) notify the health care provider.
B) administer PRN doses of an anticholinergic drug.
C) offer a reward when the patient stops these motions.
D) counsel the patient that the movements are annoying to others.

Question 9

A patient diagnosed with schizophrenia has taken thiothixene (Navane) 5 mg/day for 4 years with good symptom control. Today, the patient is admitted with paranoia and auditory hallucinations. The nurse should determine if the patient's symptoms are related to:

A) not taking the drug as prescribed.
B) activation of serotonin receptors.
C) development of tolerance to the drug.
D) an expected illness-exacerbation cycle.

Question 10

A patient is being switched to clozapine (Clozaril) from therapy using a traditional antipsychotic. The patient asks, "What's the advantage of the new drug?" Select the nurse's best response.

A) "It is much less expensive."
B) "It has a lower risk for seizure activity."
C) "It is sometimes effective when other drugs fail."
D) "It has a lower risk for causing blood abnormalities."

Question 11

Which drug would a nurse expect to produce a favorable response for both positive and negative symptoms?

A) Haloperidol (Haldol)
B) Risperidone (Risperdal)
C) Fluphenazine (Prolixin)
D) Trifluoperazine (Stelazine)

Question 12

A patient receives a traditional low-potency antipsychotic medication. The nurse should assess closely for:

A) urinary frequency.
B) urinary retention.
C) hypertension.
D) diarrhea.

Question 13

Which third-generation antipsychotic medication acts by stabilizing the dopamine system?

A) Aripiprazole (Abilify)
B) Ziprasicone (Geodon)
C) Quetiapine (Seroquel)
D) Risperidone (Risperdal)

Question 14

A patient diagnosed with schizophrenia tells the clinic nurse, "I stopped taking my antipsychotic medication two days ago." Previously, the patient was compliant and had good symptom control. What assessment finding would the nurse expect at this visit?

A) Mood instability
B) Paranoid delusions
C) No evidence of symptoms
D) Mental clouding and confusion

Question 15

When assessing for a positive outcome to drug therapy with fluphenazine (Prolixin), the nurse would look primarily for improvement in:

A) hallucinations.
B) range of affect.
C) personal hygiene.
D) social interactions.

Question 16

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, which aspect of physical assessment is most important?

A) All vital signs
B) Urinary output
C) AIMS scale
D) Temperature

Question 17

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic. The nurse should further assess for what complication?

A) Acute dystonia
B) Tardive dyskinesia
C) Drug-induced parkinsonism
D) NMS

Question 18

An adult diagnosed with schizophrenia was started on clozapine (Clozaril) 4 days ago. At 2100 today, the patient's vital signs are temperature 101° F; pulse 143 beats/min; respirations 20 breaths/min; blood pressure 100/60 mm Hg. What is the nurse's best action regarding the 2100 dose of clozapine?

A) Recognize the alterations in vital signs as typical for early therapy, and administer the medication.
B) Hold the medication, and notify the health care provider.
C) Give the drug and continue to monitor vital signs every 4 hours.
D) Postpone the dose until vital signs are normal.

Question 19

A patient is diagnosed with neuroleptic malignant syndrome. Which medication from the patient's pharmacologic profile most likely led to this problem?

A) Divalproex sodium (Depakote)
B) Amitriptyline (Elavil)
C) Haloperidol (Haldol)
D) Paroxetine (Paxil)

Question 20

A patient who takes haloperidol (Haldol) 10 mg/day orally developed restlessness, agitation, and an inability to sit still. The nurse then administered a PRN dose of haloperidol 5 mg intramuscularly. One hour later the patient's symptoms were worse. What is the most likely explanation?

A) The PRN medication has not yet taken effect.
B) The patient needs an additional PRN dose of haloperidol to control the rising agitation.
C) The patient was experiencing akathisia, which worsened after receiving the PRN medication.
D) The nurse should consider an adjunctive dose of an antianxiety drug such as lorazepam (Ativan).

Question 21

When comparing major differences between traditional and atypical antipsychotic drugs, which statements are correct? Select all that apply.

A) Traditional antipsychotic drugs produce more EPSEs.
B) Traditional antipsychotic drugs are more likely to produce weight gain.
C) Traditional antipsychotic drugs alter dopamine and serotonin transmission.
D) Atypical medications have a greater therapeutic effect on both positive and negative symptoms.
E) Atypical medications are more likely to cause tardive dyskinesia.

Question 22

A patient is to be discharged on a maintenance dose of a high-potency antipsychotic medication. Which remark indicates that discharge teaching about the medication was effective?

A) "I will be able to have a few glasses of wine."
B) "I have to use sun block when I go to the beach."
C) "It is important for me to dress warmly in all seasons."
D) "If I miss a dose, I will take an extra one the next day."

Question 23

Patient teaching for individuals taking risperidone (Risperdal) should include (select all that apply):

A) measures to prevent episodes of orthostatic hypotension.
B) strategies to maintain fluid and electrolyte balance.
C) importance of determining monthly WBC count.
D) dietary management to avoid weight gain.
E) self-monitoring for facial tics.

Question 24

A 60-year-old female patient who has taken traditional antipsychotic medication for 20 years should be screened for:

A) osteoporosis.
B) metabolic syndrome.
C) polycystic ovary disease.
D) NMS.

Question 25

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic. The nurse anticipates that the health care provider will prescribe:

A) olanzapine ( Zyprexa ).
B) dantrolene ( Dantrium ).
C) benztropine ( Cogentin ).
D) chlorpromazine ( Thorazine ).

Question 26

A nurse cares for four patients diagnosed with schizophrenia who are receiving antipsychotic medication. Which patient will receive the nurse's priority attention? The patient:

A) with diaphoresis and a temperature of 104° F
B) who reports feelings of neck and shoulder stiffness
C) who reports auditory hallucinations of church bells clanging loudly
D) who chants, "I am the messiah, delivered to earth from the heavens above"

Question 27

A nurse reviews laboratory reports for a patient who has taken clozapine (Clozaril) for 1 year. Which value would prompt the nurse to notify the health care provider of the need to suspend treatment? The total WBC count and granulocyte count are:

A) 2900 cells/mm³ and 1450 cells/mm³.
B) 3500 cells/mm³ and 1850 cells/mm³.
C) 4000 cells/mm³ and 2000 cells/mm³.
D) 4500 cells/mm³ and 2500 cells/mm³.

Question 28

Which information should the nurse include in the teaching plan for a patient receiving clozapine (Clozaril)?

A) "Abstain from using tobacco products."
B) "Increase your daily carbohydrate intake."
C) "Notify your health care provider if you start drooling."
D) "You will need monthly electrocardiographic tracings done."